Travel and vacation after retirement are two top goals for seniors. Whether that vacation take place in another state or across the country, you won’t want anything holding you back when the adventure gets underway—especially your health coverage.
That’s why it’s important to research your Medicare plan before you hit the road. Depending on your plan, you may not have the coverage you need once you leave home.
Original Medicare is Part A and Part B, the insurance plan administered by the federal government. Original Medicare does not have a network; you can use it with any provider who accepts Medicare, no matter where you are in the United States and its territories.
On the downside, Original Medicare generally won’t cover you if you are in another country. Only in rare circumstances will Medicare pay for healthcare in a foreign country.
For example, if you had a medical emergency while traveling through Canada to or from the lower 48 states, then Medicare will pay if the nearest hospital is a Canadian one rather than an American one.
Medicare is designed to pay for healthcare services in the U.S. If you are traveling overseas, you’ll need a supplemental travel insurance policy, or you’ll be responsible for the full cost of your care.
A Medigap plan helps pay your out-of-pocket costs under Part A and Part B. You can use it wherever Original Medicare is accepted. If you plan on road-tripping throughout the United States, a Medigap plan will fit your traveling lifestyle.
Your Medigap policy may also cover some costs during foreign travel. Medigap plans C, D, F, G, M, and N, will provide emergency health care coverage when you travel outside of the United States up to the plan limits (typically $50,000 in lifetime benefits). These plans only pay if the emergency happens within the first 60 days of your trip. If the service is provided on day 61, Medigap benefits won’t apply.
Medicare Advantage plans are sold through private insurers. Medicare Advantage plan rules are different from Original Medicare and a Medigap plan. Most Medicare Advantage plans have more restrictive provider networks, which means your plan only pays when you get care within its network, except in an emergency.
There are four types of Advantage plans, but the most common are HMOs and PPOs.
HMOs require you to get all your routine care within the plan network, although it pays for emergency care no matter where you are within the U.S. You usually choose a primary care provider and many plans require you to get a referral for diagnostic tests and specialist appointments.
PPOs let you use any provider who accepts Medicare, but you pay a lot less out of pocket when you use network providers.
If you are traveling within the United States, a PPO plan might work for you, but your costs will be much higher when you see out-of-network providers. For example, you may pay just $20 for a doctor visit in the network, but 50% of the actual cost of the visit for out-of-network care. Note that Medicare Advantage plans have service areas based on where you live. If you plan to be away from home for a long period of time, Medicare Advantage may not be your best option.
Many Medicare Advantage plans have some type of worldwide emergency coverage. The problem is that foreign providers aren’t required to bill Medicare, which means you may have to pay your bill in full upfront and get reimbursed for covered charges by your plan.
Before you leave for your adventure abroad, check with your carrier for information on travel coverage. Travel insurance is almost always your best bet if you are planning to head overseas.
Danielle K. Roberts is the Vice President and co-founder at Boomer Benefits, where her team of experts help baby boomers with their Medicare decisions nationwide.